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12-05-2018 | Systemic lupus erythematosus | Article

Nutritional intervention in patients with juvenile systemic lupus erythematosus: protective effect against the increase in fat mass

Journal: Rheumatology International

Authors: Thais Ortiz Abad, Roseli Oselka Sarni, Simone Guerra da Silva, Daniele Machado, Fabíola I. Suano-Souza, Claudio Arnaldo Len, Maria Teresa Terreri

Publisher: Springer Berlin Heidelberg

Abstract

Patients with juvenile systemic lupus erythematosus (JSLE) usually have an increase in fat mass and decrease in lean body mass. The purpose of this study was to assess the effect of a nutritional intervention on changes in body composition and food consumption of adolescents with JSLE compared with a control group and its variation over time and to assess the association of total fat mass with clinical parameters. This randomized controlled study evaluated 31 girls. Body composition and food intake were evaluated at baseline. The patients were randomly allocated into a nutritional intervention group and a control group. The intervention group received monthly nutritional guidelines for 9 months. After this period, evaluations were repeated. The carbohydrates intake decreased in the intervention group compared with the control group (p = 0.031) at the end of the study period. Additionally, a significant decrease was observed in the intake of energy (p = 0.023), carbohydrates (p = 0.031), protein (p = 0.024), total fat (p = 0.027), saturated fat (p = 0.012), and trans fat (p = 0.029) in the intervention group between baseline and the end of the study. There was an average increase of 3.7 kg (95% CI 0.8–6.5) in the total fat mass (p = 0.013) and 0.36 kg/m2 (95% CI 0.10–0.62) in the appendicular fat mass (p = 0.007) in the control group during the study period; this finding was not observed in the intervention group. A 9-month nutritional intervention in JSLE patients improved their eating habits and protected against the excessive gain of weight and body fat.
Literature
1.
Hashkes PJ, Wright BM, Lauer MS, Worley SE, Tang AS, Roettcher PA et al (2010) Mortality outcomes in pediatric rheumatology in the US. ArthritisRheum 62:599–608
2.
Mul D, Van Suijlekom-Smit LW, ten Cate R, Bekkering WP, de Muinck Keizer-Schrama SM (2002) Bone mineral density and body composition and influencing factors in children with rheumatic diseases treated with corticosteroids. J Pediatr Endocrinol Metab 15:187–192CrossRefPubMed
3.
Regio PL, Bonfá E, Takayama L, Pereira RMR (2008) The influence of lean mass in trabecular and cortical bone in juvenile onset systemic lupus erythematosus. Lupus 17:187–192CrossRef
4.
Casella CB, Seguro LP, Takayama L, Medeiros D, Bonfa E, Pereira RM (2012) Juvenile onset systemic lupus erythematosus: a possible role for vitamin D in disease status and bone health. Lupus 21:1335–1342CrossRefPubMed
5.
Klein-Gitelman M, Reiff A, Silverman ED (2002) Systemic lupus erythematosus in childhood. Rheum Dis Clin N Am 28:561–577CrossRef
6.
Rosal MC, Ebbeling CB, Lofgren I, Ockene JK, Ockene IS, Hebert JR (2001) Facilitating dietary change: the patient-centered counseling model. J Am Diet Assoc 101:332–341CrossRefPubMed
7.
Hearth-Holmes M, Baethge BA, Broadwell L, Wolf RE (1995) Dietary treatment of hyperlipidemia in patients with systemic lupus erythematosus. J Rheumatol 22:450–454PubMed
8.
Shah M, Kavanaugh A, Coyle Y, Adams-Huet B, Lipsky PE (2002) Effect of a culturally sensitive cholesterol lowering diet program on lipid and lipoproteins, body weight, nutrient intakes, and quality of life in patients with systemic lupus erythematosus. J Rheumatol 29:2122–2128PubMed
9.
Davies RJ, Lomer MC, Yeo SI, Avloniti K, Sangle SR, D’Cruz DP (2012) Weight loss and improvements in fatigue in systemic lupus erythematosus: a controlled trial of a low glycaemic index diet versus a calorie restricted diet in patients treated with corticosteroids. Lupus 21:649–655CrossRefPubMed
10.
Everett ST, Wolf R, Contento I, Haiduc V, Richey M, Erkan D (2015) Short-term patient-centered nutrition counseling impacts weight and nutrient intake in patients with systemic lupus erythematosus. Lupus 24:1321–1326CrossRefPubMedPubMedCentral
11.
Helba M, Binkovitz LA (2009) Pediatric body composition analysis with dual-energy X-ray absorptiometry. Pediatr Radiol 39:647–656CrossRefPubMed
12.
Hochberg MC (1997) Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 40:1725CrossRefPubMed
13.
Marshall WA, Tanner JM (1969) Variations in pattern of pubertal changes in girls. Arch Dis Child 44:291–303CrossRefPubMedPubMedCentral
14.
ABEP (2012) Critério de classificação econômica do Brasil (Socioeconomic classification criteria in Brazil). Associação nacional de empresas de pesquisas (National associations of research companies), São Paulo
15.
Anção M, Cuppari L, Draibe A, Sigulem D (2002) Programa de apoio à nutrição-NutWin versão 2.5 (Nutrition Support Program—NutWin 2.5 version). Department of Informatic in Health, SPDM—UNIFESP, São Paulo
16.
TACO (2011) Tabela Brasileira de Composição de Alimentos (Brazilian List of Food Composition). 4th edn. Nepa-Unicamp, Campinas
17.
Gladman DD, Ibañez D, Urowitz MB (2002) Systemic lupus erythematosus disease activity index 2000. J Rheumatol 29:288–291PubMed
18.
Gladman D, Ginzler E, Goldsmith C, Fortin P, Liang M, Urowitz M et al (1996) The development and initial validation of the Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage index for systemic lupus erythematosus. Arthritis Rheum 39:363–369CrossRefPubMed
19.
Saghaei M (2004) Random allocation software for parallel group randomized trials. BMC Med Res Methodol 4:26CrossRefPubMedPubMedCentral
20.
Institute of Medicine (2003). Dietary reference intakes: applications in dietary planning. National Academies Press, Washington, DC
21.
Elkan AC, Anania C, Gustafsson T, Jogestrand T, Hafström I, Frostegård J (2012) Diet and fatty acid pattern among patients with SLE: associations with disease activity, blood lipids and atherosclerosis. Lupus 21:1405–1411CrossRefPubMed
22.
Borges MC, Santos FMM, Telles RW, Lanna CC, Correia MI (2012) Nutritional status and food intake in patients with systemic lupus erythematosus. Nutrition 28:1098–1103CrossRefPubMed
23.
Caetano MC, Ortiz TT, Terreri MT, Sarni RO, Silva SG, Souza FI et al (2009) Inadequate dietary intake of children and adolescents with juvenile idiopathic arthritis and systemic lupus erythematosus. J Pediatr 85:509–515CrossRef
24.
Silva SGL, Terreri MT, Abad TTO, Machado D, Fonseca FLA, Hix S et al (2018) The effect of nutritional intervention on the lipid profile and dietary intake of adolescents with juvenile systemic lupus erythematosus: a randomized, controlled trial. Lupus 27(5):820–827CrossRefPubMed
25.
Chahal N, Wong H, Manlhiot C, McCrindle BW (2014) Education for lifestyle-based management of hyperlipidemia in children enhanced by a collaborative approach. J Clin Lipidol 8:187–193CrossRefPubMed
26.
Lilleby V, Haugen M, Mørkrid L, Frøslie KF, Holven KB, Førre O (2007) Body composition, lipid and lipoprotein levels in childhood-onset systemic lupus erythematosus. Scand J Rheumatol 36:40–47CrossRefPubMed
27.
Sule S, Fontaine K (2016) Abnormal body composition, cardiovascular endurance, and muscle strength in pediatric SLE. Pediatr Rheumatol Online J 14:1–6CrossRef
28.
Sinicato NA, Postal M, Peres FA, Peliçari KO, Marini R, Santos AO (2014). Obesity and cytokines in childhood-onset systemic lupus erythematosus. J Immunol Res 2014:162047CrossRefPubMedPubMedCentral
29.
Pou KM, Massaro JM, Hoffmann U, Vasan RS, Maurovich-Horvat P, Larson MG et al (2007) Visceral and subcutaneous adipose tissue volumes are cross-sectionally related to markers of inflammation and oxidative stress: the Framingham Heart Study. Circulation 116:1234–1241CrossRefPubMed